Achievements and challenges of implementation in a mature iCCM programme: Malawi case study

Area of Science:

• Child Health
• Public Health Interventions
• Health Systems Strengthening

Background:

• Malawi's integrated community case management (iCCM) program, led by the Ministry of Health (MOH), relies on donor support.
• The Rapid Access Expansion (RAcE) program (2013-2017) aimed to expand and strengthen iCCM services in four districts.
• This study evaluates iCCM program performance and implementation strength in RAcE districts to inform future improvements.

Purpose of the Study:

• To examine the performance and implementation strength of Malawi's iCCM program in RAcE districts.
• To assess changes in child healthcare-seeking behaviors and treatment over the project period.
• To identify factors influencing iCCM service utilization and caregiver perceptions.

Main Methods:

• Household surveys conducted at baseline and endline in RAcE districts.
• Interviews with primary caregivers of sick children under five to assess care-seeking and treatment.
• Surveys with Health Surveillance Assistants (HSAs) to evaluate iCCM implementation strength.

Main Results:

• Care-seeking and fever treatment from HSAs improved, but less than half of sick children were brought to an HSA.
• Caregiver preference shifted away from HSAs, with decreased perceptions of their quality and convenience.
• HSA supervision and mentorship fell below MOH targets; medicine stockouts negatively impacted care-seeking.
• Moderate access to iCCM services (HSA available 2-4 days/week) correlated with increased care-seeking, treatment, and positive perceptions.

Conclusions:

• Well-equipped and supported HSAs are crucial for effective iCCM service delivery.
• Further qualitative research is needed to address implementation challenges and identify solutions.
• Malawi's iCCM program has a solid foundation but requires enhancements to improve care continuity and child health outcomes.